Key takeaways:
- A systematic review of 127 studies found endometriosis is more prevalent than adenomyosis across multiple global populations.
- Diagnostic methods varied widely, with laparoscopy most common for endometriosis and histology or MRI frequently used for adenomyosis.
- Endometriosis showed higher prevalence in the general population (5%) compared with adenomyosis (1%).
- Among patients with infertility, prevalence reached 38% for endometriosis and 31% for adenomyosis.
- Surgical experts emphasize methodical techniques for identifying atypical lesions to improve endometriosis management.
Endometriosis rates are greater than adenomyosis rates in multiple populations, according to a recent study published in Reproductive Biology and Endocrinology.1
Ectopic endometrial tissue is the source of both endometriosis and adenomyosis, which significantly and adversely impact long-term patient wellbeing and quality of life. Access to epidemiological data has been linked to timely and effective intervention, alongside public health management and decision-making.
“However, the limited focus on non-cancerous diseases and the heterogeneous nature of adenomyosis and endometriosis have resulted in complex and varied epidemiological data, leading to a lack of comprehensive and consistent conclusions,” wrote investigators.
Developing endometriosis and adenomyosis profiles
The systematic review was conducted to develop a comprehensive epidemiological profile of both endometriosis and adenomyosis. Articles were obtained from the Embase, PubMed, Web of Science, and Google Scholar databases.
Articles clearly defining endometriosis or adenomyosis, reported the prevalence of these conditions or making the rates available to calculate, and having original research with full text accessible were eligible for inclusion. Title and abstract screening were performed by 2 independent reviewers, followed by full-text screening.
Data about publication year, country, first author, study design, age, survey period, population characteristics, diagnostic methods, number of patients, inclusion and exclusion criteria, diagnostic criteria, and total sample sizes were extracted. Publication periods included before 2010, 2010 to 2017, and 2017 to 2024.
Geographic distribution and diagnostic approaches
There were 127 studies included in the final analysis, 59 of which focused on adenomyosis and 68 on endometriosis. Of the former, 54.2% were from Europe and 23.7% from Asia, with 34 using histological analysis as the diagnostic standard, 9 magnetic resonance imaging, 14 ultrasound examination, and 2 a combination of these methods.
For studies assessing endometriosis, 47.06% were from Europe, and 16.18% were from Asia. Laparoscopy was the most common diagnostic method, utilized in 26 studies. This was followed by histology and imaging in 11 and 8 studies, respectively.
Similar rates of focal and diffuse adenomyosis were reported across 8 studies, at 17% and 15%, respectively. When examining endometriosis, a greater prevalence in the ovaries was reported vs superficial peritoneal endometriosis and deep infiltrating endometriosis, at 13%, 6%, and 10%, respectively, across 8 studies with significant heterogeneity.
Factors linked to adenomyosis and endometriosis
In patients with infertility, a combined prevalence of 31% was reported for adenomyosis across 7 studies, vs 38% across 18 studies for endometriosis. Adenomyosis was more often detected by histopathology and magnetic resonance imaging, with rates of 35.1% and 35%, respectively, vs 30.7% for ultrasound.
Additional factors associated with increased adenomyosis prevalence included hysterectomy for benign vs malignant conditions, having given birth, and experiencing gynecological symptoms. For the latter population, a prevalence of 1% was reported, which was equal to the rate of endometriosis in these patients.
Endometriosis was more common in the general population, with a rate of 5%. A rate of 34% was reported in nulliparous women vs 26% in parous women. In comparison, adenomyosis was reported in 1% of the general population, highlighting a decreased prevalence vs endometriosis.
“In individuals with gynecological symptoms, the prevalence may be even higher, potentially approaching 50%,” wrote investigators.
Surgically managing endometriosis
To manage endometriosis in patients, Trina Mansour, MD, a gynecologic surgeon from the Phoenix VA Healthcare System, highlighted surgical methods during a presentation at the 2025 American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting.2
Mansour noted that a methodical technique is vital for success in endometriosis surgery, as atypical lesions can be more easily identified when the same procedure is performed for each case. According to Mansour, the procedure should start with a comprehensive survey of the upper abdomen, working clockwise to detect atypical lesions.
“I always recommend excising any suspicious lesions, even though it might not be the typical powder burn, because that will help increase confidence in identifying those atypical appearances and making sure that we're fully excising disease,” said Mansour.
